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General NPI Number Information
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NPI Number | 1164769113
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Entity Type | Individual
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Provider Name | JERROLD DOUGLAS LEVENGOOD PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 2685 N FOREST RIDGE BLVD
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City | HERNANDO
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State | FL
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Zip | 34442-5123
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Country | US
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Telephone | 352-527-6554
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Fax | 352-527-0789
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Provider Business Mailing Address
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Address Line | 2685 N FOREST RIDGE BLVD
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City | HERNANDO
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State | FL
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Zip | 34442-5123
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Country | US
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Telephone | 352-527-6554
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Fax | 352-527-0789
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS35795
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License Number State | FL
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